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anti

Anetus.

termit

Medical treatment.

maintain the action longer, and hence make a double Gen II. effort to accelerate the sweating stage. The antimonial preparations differ chiefly from each other by having the tent fever. reguline part of the antimony they contain in a more or less fusible state ; and their operation will often vary ac- Antimo cording to the quantity or quality of the acid they meet nials. with in the stomach ; and hence the different effect of the The same

preparation same preparation in different persons, and even in the often affects same person at different times. The rubinus antimonii, different inor antimonial febrifuge of Craanen, was at one time re- differently. garded as a specific in intermittents on the continent, and was in particular favour with Stahl, Dieterech, Vogel, and many other physicians of reputation ; but it does not appear to be of superior efficacy, in any respect, to the antimonial powder of the London College. . The most efficacious practice which I have witnessed, Relaxants

combined consists in uniting relaxants with opiates; and, where with opiates this joint effort is pursued, ipecacuan may answer as well as any of the preparations of antimony. We cannot have, for this purpose, a more useful medicine than Dover's powder; and it should be commenced with much earlier than is consistent with the usual practice, so as not to regulate the hot and sweating stages, but to anticipate the cold fit. And we may still farther add to the ingredients of the medicine a full dose of volatile alkali with great advantage; for it is in this form, if in any, that we can employ stimulants with a certainty of doing little mischief, and very nearly a certainty of considerable benefit. In the case of a quartan in St. Thomas's Case sucHospital which had lasted two years, Dr. Fordyce de

e treated by termined upon this plan; and prescribed a full dose of Fordyce. Dover's powder with a sweating draught of carbonate of ammonia two hours before the paroxysm was expected. It succeeded perfectly. . A profuse perspiration anticipated the period of the cold fit, and hereby entirely prevented it; bark was next given freely, and this obstinate ague was cured in a few days *

Edinb. Med. Comment. Vol. vi. p. 359.

treatment.

Diluents

means,

Gen. II. How far the use of Dippell's or any other animal oil Anetus. might be sorvinohlason Interunit might be serviceable as an antispasmodic in intermittents, tent fever. I cannot say. · Dr. Hoffman was highly impressed in Medical

their favour; and asserts that a single dose of from Animal oils. twenty to thirty drops, given six hours before the ac

cession of an intermitting fever, will frequently prove a complete cure to the complaint. They appear certainly to be sedative and diaphoretic, and it is said that the sweat they excite by a single dose may continue for twenty-four hours without languor or debility. As a medicine, these oils have perhaps been thrown aside too hastily.

Whatever be the relaxant or sudorific employed, it and other

should be assisted by plentiful potations of warm diluents auxiliary

and by placing the patient between the blankets instead of in the sheets of his bed: for I have already had occasion to observe that upon these auxiliary means depend, in many instances, the accomplishment of the object we have in view, without which the most urgent diaphoretic

exerts itself to no purpose. Period of The most important season, nevertheless, for medical intermission chiefly to be operation is in the intermission of the paroxysms: since, depended however successful we may be in moderating the febrile upon.

attack, it is rarely that we can depend upon any plan which may then be adopted to prevent a recurrence of

the fit. Tonics ; and The opinion of mankind seems to have concurred in their properties as most ages, in regarding debility as either the proximate bitters and or predisponent cause of intermittents, since almost the astringents.

only medicines that have been brought forward to guard against the recurrence of their periodic attacks have been TONICS, with the sensible qualities of bitterness or astrin

gency, or of both. In what way. In what way these act upon the moving fibre at any they act.

time, and particularly in the disease before us, we cannot say with any degree of precision. The tone of the moving fibre depends unquestionably in some degree upon the state of the fibrous material itself, but perhaps in a much greater degree upon the quantity or quality of the nervous fluid that issues from the brain and is com- Gen. II. a municated to the fibrous structure, or as it is modified in Anetus: any particular set of fibres. We have great reason for tent fever. believing that astringents, in producing tone, act upon A

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upon Medical the fibrous material itself, for we find them operating treatment. in a like manner upon animal fibres both in a living and a dead condition. But whether, as Dr. Cullen conjectures, it be the part of bitters alone to act upon the nervous power or living principle which adheres to them, and especially in the very singular manner in which he represents them as acting, is a different question; and the present is not the place for entering upon it.

If we contemplate the nervous fluid as a peculiar secretion, and the brain as the secreting organ, we can readily conceive that the component parts of this organ as well as of any other may be invigorated by medicines that have a peculiar influence on its structure, and probably concentrate and give tension to its fibres; and that, in consequence hereof, it may be rendered capable of secreting its proper fluid in greater abundance, or a more elaborate perfection. And we can also readily conceive that such effects may be produced by both bitters and astringents, as well as by medicines that possess some other sensible qualities, though these are the most obvious in their operation. But should we, with Dr. Cullen, Cullen's affirm that the same bitter employed in the same propor- hyp

unsatisfaction, produces both tone and atony, energy and debility; tory. that it both cures the gout, and occasions it; that employed for a certain time it effects the former, and, after such time, the latter; and should we beyond this affirm, with him also, that the nervous fluid is not a secretion, but an inherent power of the brain; that it admits neither of increase nor diminution; is changeable in its state, but unchangeable in its essence; becomes excited and collapsedy or rises and falls in its energy, but experiences nothing of the decomposition, or recruit of every other part of the living frame around it; we should travel into. a labyrinth of incongruities, and only enlighten ourselves". with a will-o'the-wisp. Dr. Cullen's system, like him

VOL. II.

nesis

Anetus. Intermittent fever, Ague. Medical treatment. Cinchona.

Gen. II. self, is a work of no ordinary stamp; it is full of immor

tality, but mixed up with weak and perishable materials.

Of the remedies appertaining to the one or the other of the two divisions we are now considering, those of astringents and bitters, the cinchona or Peruvian bark, which unites both qualities in itself, is on every account entitled to our first attention.

This valuable medicine, which some practitioners are apt to despise or think lightly of in the present day, has never been altogether without its opponents; and there are many facts respecting its operation, which, if not

altogether anomalous, are of very difficult solution. . History of Peruvian bark, according to the authority of Don Joits introduction into seph Villerobel, a Spanish physician noticed by Badus, Europe. was first brought to Spain in the year 1632; but here,

as in every other country, it had for a long series of years to encounter the prejudices of the medical profession; and consequently was very rarely made use of, and unquestionably would have sunk into oblivion but for the activity of the Spanish Jesuits, who continued zealously to recommend it, and to import large quantities of it from their brethren in South America. Through these means it was at last recommended by Pope Innocent X. in 1661, as a medicine perfectly innocuous and salutary: and a Schedula Romana, drawn up under the sanction of the physician to his holiness, pointed out in express terms, the time and proportion in which the bark was to be taken. Unfortunately the time stated was frigore febrili incipiente, “ at the commencement of the cold fit”: and it being administered in this manner with only temporary benefit to the Archduke Leopold of Austria, a year or two afterwards, it immediately fell into great discredit with a very large and learned part of the medical community of Europe; and a most acrimonious warfare was instantly waged in every quarter on the subject, in which the combatants on both sides seemed

more desirous of victory than of truth. When in- In our own country the bark began to become poputroduced

lar about 1655. In 1658, Mr. Underwood, an Alder

into

land.

intermit

ledical

presiden who have counce

man of the city of London, died while using it, and was Gen. II. instantly reported to have fallen a sacrifice to its power ; ;

• Anetus. and so prejudicial was the effect of this rumour, that tent fever. Cromwell, who was attacked with an ague in the same year, was suffered to languish and at length to die without treatment. an exhibition of the bark, his physicians being afraid to make a trial of it in consequence of the fatal accidents that had so lately accompanied its use: in the words of Morton, “nondum vires corticis in hoc veneno subigendo, saltem hic loci, comprobatæ erant”*. In England, therefore, as well as on the continent, Begins to

be countethere was a great conflict of opinion. Dr. Prejean, who nanced. both preceded and succeeded Dr. Harvey as president of the College of Physicians, appears openly to have advocated its employment in 1658, according to facts adverted to by Sir George Baker in his admirable artiele on intermittent feverst, from which these hints are chiefly drawn up. Dr. Brady, professor of physic at Cambridge, appears equally to have countenanced it; as does Dr. Willis according to his own statement: while Dr. Morton professed himself inexperienced upon its virtues, and Dr. Sydenham was decidedly adverse to its use.

Sydenham, however, was a man of reason and libera- Candour of lity. His prejudices, and especially those derived from

Sydenham. the hypothesis that a fever is a fermentation in the blood raised by nature to throw off some peccant matter at the surface, and which ought not therefore to be checked in its course, however wise it may be to moderate it in its violence, were all at arms against the use of the bark under any circumstances : and the mischievous effects to which he had been an eye-witness in some instances, and its total inertness in more, gave a sanction to suspicion, if it did not justify hostility. But he was determined to watch it for a still longer period through all its variable effects, and to abide by the result when fairly cast up. He soon became sensible that it was, in most cases, a power

* Pyretolog. p. 17.

+ Medical Transactions, Vol. vi, Art. XIII,

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